Dr. Marc Gillinov: Heart Health, Chocolate, and Wine

Dave Douglas: Hi, welcome to another episode of Up2. Eight years ago Up2 started as a live event series showcasing leaders who are as humble as they are successful. The humility piece is extremely important as we identify leaders who can inspire others. We try to focus our interviews on the non-business aspects of their lives and in doing so have found that there's a real thirst to explore their hearts and minds in atypical ways.

Dave Douglas: Our host, as always is Adam Kaufman and our guest today is Dr. Marc Gillinov. He's a heart surgeon at the Cleveland Clinic, the number one rated heart center in the United States. In fact, he's the chair of the thoracic and cardiovascular surgery department, so he's an incredibly skilled surgeon and in a position of great importance at the Cleveland Clinic.

Dave Douglas: He'll start by telling us a little bit about what he does and how his time has managed among all of his responsibilities. He'll talk about the journey, getting to this position and about some of the choices that he had to make along the way. Dr Gillinov. We'll touch on his family and his introduction to surgery as a child listening for the moment when he says, "It's not that hard."

Dave Douglas: Our host, Adam Kaufman, will ask how he views his patients and how he copes with the stress and the gravity of being a heart surgeon. And we'll get answers to some of the biggest questions like is red wine good for your heart? And what about dark chocolate? Dr. Gillinov will also talk to us a little bit about what he's excited about in the future of heart medicine right now. We're excited that you've joined us here on the Up2 podcast. We'll be right back. (Music).

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Dave Douglas: Welcome back. You're listening to the Up2 podcast and here's your host, Adam Kaufman.

Adam Kaufman: We are very excited today and we thank you for downloading this special episode. Today, we're recording on location inside one of the most renowned hospitals in the world. Our guest today is the Chairman of Heart Surgery at the top ranked heart center in the United States. Given that the Cleveland Clinic has been ranked number one in heart care for 25 straight years, and the fact that our guest today's the Chairman of that top rank team, it would not be an exaggeration to state that we are visiting with the most sought after heart surgeon in the United States. A graduate of Yale university and Johns Hopkins medical school where he was ranked number one in his class. Our guests is today considered a global leader in robotic heart surgery, mitral valve repair, and among other subspecialties atrial fibrillation. He has written more than 400 medical publications, has been a member of 10 scientific societies. He has been granted several patents for his surgical inventions and he's won many awards for both innovation and also service excellence.

Adam Kaufman: Somehow, today's guest on the show also has served as the chief experience officer and he selectively travels to almost every corner of the U.S. And abroad to deliver speeches. To both the medical community and also the general public. Our guests also found the time to coauthor Heart 411, a book I honestly loved reading, which has been called "The Definitive Guide for Heart Health in America". Dr. Gillinov welcome to Up2.

Marc Gillinov: Thank you. It's good to be here.

Adam Kaufman: Well, what have you been up to?

Marc Gillinov: Two things. Operating and talking. Sometimes talking to patients, sometimes talking about patients, sometimes talking about operating, but for the most part operating and communicating.

Adam Kaufman: Do you think you have a good understanding of how much, if you know the day is 100% like what percent is doing each of the things? I'm really interested in how busy people achieve so many different pursuits. How do you break that down?

Marc Gillinov: About 30%, maybe 40% actually in the operating room doing operations, another 30% or so talking to patients, talking before surgery, talking after surgery, talking to patients' families, and the rest is either research or administration, things that help our department keep going.

Adam Kaufman: So you're in a leadership position outside the surgery room. Is that something you sought out or it's just kind of goes with the portfolio of responsibilities as you achieve more? Or do you find yourself sometimes missing more time with the patients?

Marc Gillinov: I still have enough time with the patients. I sought out leadership once I was confident in my surgical ability. So I did have the opportunity about 10 years ago to apply to be leader of our department and I chose not to because I thought I can still get to be a better doctor. I can still work toward being a better surgeon. And of course every day, every day I can get better. But I felt 10 years ago I needed more time to focus on my primary calling, which is to operate on people and fix their hearts. So I wasn't ready to transition to something else till I was truly satisfied that yes, operating, I've got that down.

Adam Kaufman: Your humility is coming out here. You had the humility to know 10 years ago, "No. Let's wait a little longer. Let's hone our skills. Let's continued with the innovation on the surgery side before we apply for leadership." So was that a big decision? Or were some of your colleagues saying, "You should go for it."? Or do you have any mentors coaching you through a decision like that?

Marc Gillinov: Almost everyone said you should go for it.

Adam Kaufman: Really"

Marc Gillinov: You're the natural person at this time.

Adam Kaufman: I probably told you that back then.

Marc Gillinov: But it was tough to say no because yes, I want it to be a leader, but I didn't want to leave unfinished business. The unfinished business being take what I learned in medical school and learned in residence and I've learned since I arrived at Cleveland Clinic in 1997, take that as far as I can before I move on to the next thing. I felt that going for leadership 10 years ago would be leaving unfinished business. How good could I get as a surgeon?

Adam Kaufman: I guess I'm not surprised. But I am surprised that so many of your colleagues were pushing you to take on that leadership role some time ago. So I know there's been a lot of patients between then and now who are glad that you didn't. How many surgeries do you perform a day or a month or however you count it? Maybe 350 to 400 a year. So 400 a year, 10 years, several thousand lives positively affected, and their families, because of your continued work in the surgical center.

Marc Gillinov: Yeah, and I'm ultimately happy with my decision. I had no idea that I would have another opportunity to rise here at Cleveland Clinic. I'm glad it worked out that way because I would have hate to have had to leave, go somewhere else to advance. Specifically, because I don't think there's any place like this in the world.

Adam Kaufman: 65,000 employees, almost 5,000 physicians now and ranked number one by the most reputable ranking source, US News, 25 straight years. It really is remarkable. But I know you have been recruited and I'm sure other organizations flirt with you all the time, but I'm sure the institution here is so glad you stayed.

Marc Gillinov: I'm glad I said I go look at other institutions every year I travel, whether recruited or not, and visit two, three or four hospitals and every one of their cardiac surgery teams I will find does something a little better than what we do.

Adam Kaufman: Again, your humility.

Marc Gillinov: So we bring it home.

Adam Kaufman: Oh, okay. It's collaborative.

Marc Gillinov: We bring it home. Well, we see something that looks good. Suddenly I have maybe looks better than what we do here. We try it.

Adam Kaufman: Let's step back a little bit further in time because I know early on you, growing up close to the Cleveland Clinic, thought you might want to work at the Cleveland Clinic. Did you always know that you'd go into the heart category or was it more general medicine and then deciding on heart care later?

Marc Gillinov: Heart category.

Adam Kaufman: Right away?

Marc Gillinov: I had family members who had heart surgery, heart attacks, heart problems while I was growing up, so I was naturally interested in the heart. It was likely one way or another I would be involved with the heart either as a patient or as a doctor. So far, thankfully as a doctor who helps patients.

Adam Kaufman: Right.

Marc Gillinov: But I had an internally developed interest in the heart because of what my family members were going through.

Adam Kaufman: We're all born into somebody else's story. And that story shapes our early years, at least the decisions we make. It sounds like some of that health history in your family shaped your career path early on.

Marc Gillinov: Yes. Yeah.

Adam Kaufman: And it will be hard to talk about this cause you are so humble. But was it clear early on that you had a gift for medicine or was it something you really had to work at? Because athletes, other types of leaders, they know they have certain gifts at a pretty early age. I assume that's true for you. I assume you're not going to want to talk about that, but when did you know that this was the right path for you?

Marc Gillinov: My dad was an OB-GYN and he would bring home instruments that we use to sew in the operating room and he would give them to me and he would teach me when I was in high school. How do you sew tissue? How do you put blood vessels back together? And I wouldn't say that it was immediately apparent, "Oh, I know how to do this." It wasn't. But I found that I could learn how to do it.

Marc Gillinov: I think there's almost no one who's born a fabulous gifted surgeon. We just all start at a certain place, and then develop it and it's not that hard. Almost anyone can develop it. I did have-

Adam Kaufman: I bet that's not true.

Marc Gillinov: Well, the most natural surgeon I've ever seen in a first time handling instruments situation was a Navy Seal. We had a Saturday morning with some Navy Seals discussing leadership and teaching and organization-

Adam Kaufman: With them or here at the clinic?

Marc Gillinov: They came to us. I was at a table in which we had residents and Navy Seals. Neither one of them had experience handling surgical instruments. My job was to explain how to sew two blood vessels together. We had artificial blood vessels. And then coach them through it. The residents did okay, and I thought my teaching was fine. Then we handed the instruments, the Navy Seal. He picked up the needle holder and the suture and said, "Something like this?" And I said, "Not something like that. Exactly like that." So perhaps he's the only truly gifted surgeon I've encountered, but he has other things he's busy doing.

Adam Kaufman: That's amazing. Now, do you think that was just random because he's a gifted human being, a polymath, or do you think there's something in his training as a Seal that led to that aptitude?

Marc Gillinov: He's like a gifted human being because in talking with him and some of the other Seals, it looks like hard work is not enough to become a Navy Seal.

Adam Kaufman: Remarkable.

Marc Gillinov: You need a little something extra that you're born with.

Adam Kaufman: Right. Wow. Well, when we sat down today, I handed you a photograph that a close friend of mine wanted you to see of his father-in-law, 14 family members around. You did the heart surgery seven years ago. And my friend's point was how do you put a price tag on the memories that have now been shared because of the great work you and your team did.

Adam Kaufman: You have an experience like that almost every day, this family experienced it once. How do you think about the impact you're having? Or do you try to limit that so we don't have a godlike syndrome or how do you manage your pride? We all know surgeons who are really full of themselves. You're the opposite of that. But you get all these accolades. So how do you emotionally deal with confidence, but humility, pride, et cetera?

Marc Gillinov: It's pretty easy. I think back every day to a day when one of my kids had an operation and what it felt like to be in the waiting room. I also think back to the times when I needed to reach that doctor, when things weren't going as expected, when there were issues and how important it was for me to be able to reach that doctor. And how at that moment, that doctor was the most important person in my life.

Adam Kaufman: The most important.

Marc Gillinov: Need to reach him.

Adam Kaufman: Right.

Marc Gillinov: I, therefore, return the favor to my own patients.

Adam Kaufman: Do unto others as you want done to you.

Marc Gillinov: This morning I came in and made rounds and I made no medical decisions. None were necessary. My team had already made all the right moves. But I spent an hour dropping by peoples' rooms and talking to them.

Adam Kaufman: As a patient, that 10 minutes when the surgeon comes in, it's like the most important moment of the day. The whole family's waiting for it, at 6:30 in the morning or whatever time. And so you remember that as the family, yourself, when you had children in that situation?

Marc Gillinov: Yeah. I mean we might say Monday we've got 20 cases, 20 open-heart operations, which will make us that day, the busiest center in the U.S. In fact, we're the busiest center most days.

Adam Kaufman: Right.

Marc Gillinov: But they're not 20 cases. They're 20 people. For each person having heart surgery on Monday, this will be one of the biggest days of that person's life. It's right up there with marriage, child being born-

Adam Kaufman: Absolutely.

Marc Gillinov: It's a big, big deal. So we don't just do cases or operations.

Adam Kaufman: In your own training, have you had to learn how to manage stress or is that something not talked about? You just have to deal with it. I had Baker Mayfield recently as a guest and he has a different line of work and his is-

Marc Gillinov: Much bigger audience.

Adam Kaufman: Bigger audience, form of entertainment, but let's acknowledge much less important. But everyone watches his work. I asked him a lot about managing stress and compartmentalizing. So if you had to hone your own skills in managing stress? Are you good at that? Is it by grace under pressure?

Marc Gillinov: I'm sure I could be better.

Adam Kaufman: Again, the humility.

Marc Gillinov: We had in my training, no training. It's not about managing stress.

Adam Kaufman: That's amazing.

Marc Gillinov: Nothing at all. It's better now but still imperfect. Figuring out how to manage it was, "You're on your own. Just deal with it." The way we do it now in our department though, is we function much more as a team, we do a lot of operations together. If you're walked down the halls, you'll see surgeons talking to each other, going over cases, sometimes discussing things that didn't work out and what is the next move? The key factor there is no one here is alone. You don't have to manage. Your stress alone will help you.

Adam Kaufman: Is there a safe setting in which you can actually get real with maybe a colleague? "Boy, I was really stressed out today. I didn't perform at my best."

Adam Kaufman: Again like Baker Mayfield's line of work, he can do that and it's just like a missed touchdown. Challenges in your line of work have a little different level of ramification. So are you able to cope through that, counseling, anything?

Marc Gillinov: Not counseling so much.

Adam Kaufman: But a peer group or just colleague to colleague?

Marc Gillinov: Just colleague to colleague. Last week I was there for an operation that had one of my friends was doing and we ran into some trouble. We got out of trouble together and at the end he said, "I'm really glad you were there." And we are always there.

Adam Kaufman: Is that unique to this institution?

Marc Gillinov: Yes. Yeah. I had a case last year where I was operating on an ICU nurse, ICU nurse here who has been here as long as I have, 25 years, and we unexpectedly could not get off the heart lung machine. We could not get her hardworking. Now it's about 9:00 PM and there were five other surgeons still here and we all gathered together in the operating room and figured out what to do. None of us could figure out what was wrong, but we figured out together what to do. She went home about eight days later and she's fine now.

Adam Kaufman: Tremendous. One of the things I've always enjoyed seeing about you is how you can also relate to lay people, if that's the right word. Nonmedical professionals. You do such a good job of explaining things in simple terms. You were one of the first guests ever at one of our live Up2 events. I don't know if you remember like eight years ago.

Marc Gillinov: I do.

Adam Kaufman: It was only 50 people in the room, but none of them were medical. They were all CEOs of the investor community. But you had them captivated and I've had so many physicians speak to groups before were they lose the audience because they get to medical. So is that something you tried to get better at? Or is that just one of your God given talents to be able to explain things easily?

Marc Gillinov: Tried to get better. Oh yeah. The high school I went to an Cleveland, if you said, "What was the single thing that I took away from my high school?" It was learning how to write reasonably clearly.

Adam Kaufman: Communicating. Okay.

Marc Gillinov: I mean, college, same thing. Learning to write. Since getting to Cleveland Clinic, every year we bring in speech coaches to work with all of the surgeons to teach us how to communicate better.

Adam Kaufman: I didn't know that. That's interesting.

Marc Gillinov: Sometimes they're actors or acting instructors. Right now, we're working with a guy who's a Professor of Business at one of the universities locally.

Adam Kaufman: Always getting better. Just trying to get better.

Marc Gillinov: Yeah. We actually sit in this very room. We bring a podium in, simulate a talk, and he'll film it more often than not. Then we'll go over the film. I guess this is what Baker Mayfield does. He goes over his film.

Adam Kaufman: Yeah, exactly. Always trying to get better every week. Learning from their own mistakes. There's some similarities there.

Dave Douglas: You're listening to the Up2 podcast. We'll be right back.

Adam Kaufman: During the first season of the Up2 podcast, I had several companies and entrepreneurs approached me about potential partnerships, but I'm really selective before choosing to do something like that. One choice we did make happily is to partner with Vivid Front, a full service digital marketing and website design agency based in Cleveland that works with both local and national brands. They've built their entire client base on referrals and they've won a lot of awards including the 2019 Inc. Magazine, Top 5,000 Fastest Growing Companies, North coast's top places to work, and several others. They're known for their talent, they're known for their creativity, they're known for their culture. A firm I liked before we agreed to partner together for this show. Check out vividfront.com or you can email me and I'll introduce you to their dynamic leader, Andrew Spott.

Adam Kaufman: Hello, my name is Adam Kaufman and I'm thankful you're joining us today on the Up2 podcast. I want to tell you about a group that I'm grateful for and that is TownHall Cleveland's most popular restaurant and one that I can say is the only place my wife tells me she can eat every meal. Breakfast, lunch, and dinner. TownHall was the first all non-GMO restaurant in the U.S. A few years ago and they're now expanding into Columbus, Ohio soon. I'm also very selective about who we choose to partner with for this podcast and it was with open arms that I embraced the idea of partnering with Bobby George and TownHall. To learn more about what they're up to, you can visit townhallohiocity.com.

Dave Douglas: Welcome back. You are to the Up2 podcast with Adam Kaufman. Today's guest, Dr. Marc Gillinov. `QM7

Adam Kaufman: Let's talk about school. You were number one in your class in high school. You were number one in your class at Yale. You were number one in your class at Johns Hopkins, which Hopkins and Harvard are ranked the top medical schools every year. And now, you're the Chairman of Heart Surgery at the number one ranked heart center. Are you trying to be at the top or are you just simply being the best you can be and it's okay to achieve goals. So I'll give you permission to say, "Yeah," you set high goals. How do you think about this level of achievement? You always seem to get to?

Marc Gillinov: I can only try to be the best I can be, and that's about it.

Adam Kaufman: So you weren't motivated to be number one in your class?

Marc Gillinov: Oh, it-

Adam Kaufman: Is there a competitive streak in you at all? I guess that's what I'm searching for.

Marc Gillinov: Yeah, some. It's a nice thing. But there's always going to be someone somewhere who's better without a doubt.

Adam Kaufman: Right.

Marc Gillinov: It's not like the tennis rankings who, at the end of the airway say, "All right, Rafael Nadella was number one in the world." We don't have rankings like that, but-

Adam Kaufman: Not by surgeon. Right. But you are the Chairman of the number one ranked heart center?

Marc Gillinov: Yeah, and I'm happy to be here.

Adam Kaufman: That's a pretty legitimate ranking.

Marc Gillinov: We'd like to think so.

Adam Kaufman: We'd like to think so.

Marc Gillinov: We like those particular ranking.

Adam Kaufman: The humility is just unbelievable. My producer, Dave, is shaking his head. Because we feature a lot of humble, successful people, but you're just at a whole other level. We might have to think of a new title for this episode. It's so refreshing how humble you are, Marc.

Adam Kaufman: What do you like to do when you're not working? How do you relax or recharge, because your day job is pretty stressful one?

Marc Gillinov: Mostly interact with my kids.

Adam Kaufman: You have a daughter and a son, right?

Marc Gillinov: Two daughters. One son.

Adam Kaufman: Oh, okay. Forgive me.

Marc Gillinov: Son has graduated college, a daughter who's in college and a daughter who's applying to college.

Adam Kaufman: And the two went to Yale?

Marc Gillinov: No, my son went the other direction. He just graduated from Harvard.

Adam Kaufman: Okay. Was that okay with you?

Marc Gillinov: When he chose to go to Harvard over Yale, he asked me something that probably you don't hear very often. He said, "Dad, will you still be proud of me if I go to Harvard?"

Adam Kaufman: Oh my goodness. Didn't you just lean over and hug him? I mean, that's ...

Marc Gillinov: No. I said, "No."

Adam Kaufman: No you didn't.

Marc Gillinov: No. I said, "Of course."

Adam Kaufman: Is medicine in his future?

Marc Gillinov: Think so. He's applying to medical school this year.

Adam Kaufman: `Okay. And one at home, so you're going to be an empty nester pretty soon?

Marc Gillinov: Yes.

Adam Kaufman: How do you feel about that? Is that going to change the activities you and your wife do?

Marc Gillinov: Yeah, I think we will travel to see my daughters in college, to see them play tennis.

Adam Kaufman: I remember when you and I were getting to know each other when our kids were younger. You were doing a lot of tennis tournaments.

Marc Gillinov: Yes.

Adam Kaufman: That's how I was with soccer. Maybe back then we would complain about having to drive 30 or 40 minutes somewhere. But I yearn for those days now.

Marc Gillinov: There was nothing and still is nothing more stressful for me than watching my daughters play tennis.

Adam Kaufman: Is that so? See? I love, to me, it's my favorite thing watching my daughter play college soccer now. It's my favorite. You get stressed out?

Marc Gillinov: Absolutely.

Adam Kaufman: So that's where the competitive side in you comes out. Maybe not in your professional pursuits, but making sure your kids achieve.

Marc Gillinov: Competitive on the behalf of others.

Adam Kaufman: Okay. Do you play tennis still yourself?

Marc Gillinov: Rarely.

Adam Kaufman: You run?

Marc Gillinov: I'd like to, right now I'm sidelined with various orthopedic things. Nothing serious.

Adam Kaufman: Oh, what's going on. I know a good orthopedic surgeon or two. What's going on?

Marc Gillinov: I hope I don't need surgery. Achilles tendonitis, herniated disc in the back, a little bit of patellar tendonitis in the right knee.

Adam Kaufman: Let's give our listeners one factoid right now. Is it really true that red wine is better than white wine? What are the studies? Tell us?

Marc Gillinov: Depends which one tastes better to you? Medically, they're equivalent.

Adam Kaufman: Medically? See? We all think red wine's better.

Marc Gillinov: Yeah. If there's an active ingredient in wine that's good for you, it's a little bit of alcohol. Emphasis on a little bit.

Adam Kaufman: So why is this theory that red wine is somehow good for our heart so accepted? Is it a marketing thing?

Marc Gillinov: No. It comes from an old study that had investigators look at people in France, particularly in Bordeaux, and try to answer the question, "Why do these people who live in Bordeaux, France have a very low risk of heart disease? They don't have a great diet. They have a high fat, high red meat diet. They smoke a fair bit. What's the secret ingredient to their lives that is responsible for a low risk of heart disease?" And they said, "Aha, these people in Bordeaux drink a lot of red wine. Maybe that's it."

Adam Kaufman: And so that became the American conclusion that red wine is better.

Marc Gillinov: Yeah. It turns out that people who drink a little bit of alcohol on average, tend to live longer than people who don't. And on average, tend to have fewer heart attacks than people who don't. That's controversial. Not as strong enough effect that we're handing out prescriptions for red or white wine or bear or vodka or gin. But for sure, a little bit of alcohol is compatible with a healthy lifestyle and a good long life.

Adam Kaufman: So it sounds like you're saying that whether it's white wine, red wine, or even a beer or a regular sized one cocktail is equally, maybe good for the heart?

Marc Gillinov: Yeah.

Adam Kaufman: See that's surprising to me. Yeah. No one talks about it that way, but you're, you're debunking the myth. That's awesome. Very powerful. You're affecting more people than you realize by saying this right now.

Marc Gillinov: We'll see if wine sales are bear sales go up.

Adam Kaufman: Right. What about innovations on this more serious side in the surgery room? You've had some patents yourself. Are you most excited about something right now that you just got approved or that you're on the verge of bringing into the surgical center?

Marc Gillinov: The thing that we're most excited about is being able to do heart valve repairs through very small incisions, which we do with a surgical robot and it's really pretty cool.

Marc Gillinov: Making rounds this morning, looking a woman who had heart surgery on Monday. She's leaving the hospital today and she looks normal. She has a little incision on her side. You won't see it if she wears a bathing suit, even a bikini, you won't see it. And she actually had heart surgery, was on the heart lung machine. Her heart was stopped. We fixed a valve inside her heart. I think that's pretty cool to be kind of sneaky. Get in there and fix a valve and no one knows.

Adam Kaufman: The old way would have been a larger incision and a more visible scar?

Marc Gillinov: Right. Right down the middle. And we do that when that is the life saving approach, we have to save the life and do it that way.

Adam Kaufman: Of course. Can you try to explain to us in a few moments, what is it like to actually go inside somebody's heart and improve whatever the problem is? Can you walk us through that for a few moments? All of us will never have that opportunity to do that. What are you thinking about when the heart lung machine is on?

Marc Gillinov: Maybe 60 or 70 years ago, it was miraculous that you could stop someone's heart, open it up, work on the inside of the heart and close the heart and then start the heart up and have the person talking to you the next day. Now, it's not miraculous. It's happening about 50 yards from where we're sitting.

Adam Kaufman: Wow.

Marc Gillinov: So I would say that few of us think about that aspect. That's routine.

Adam Kaufman: Few of us, the surgeons, it's so routine. On a surgery day, are you doing two or three in a day?

Marc Gillinov: Yeah, usually two or three. Patients will often ask, "Are you going to stop my heart, because that sounds pretty dramatic." "Yes, I will stop your heart, but don't worry. It always starts again."

Adam Kaufman: Have you ever met a professional on a different line of work? I'm trying to think right now myself, like maybe it's a pilot who has to navigate an unexpected problem or an infantry men who is fighting for his life or someone else's. I mean this is a very sensitive moment when you're first going in making sure the heart lung machine is perfect. The anesthesiology has done the intended work, but it's just routine for you at this point. You've done it so often?

Marc Gillinov: Yeah. I've had engineers, in particular, ask a lot of questions. "Do you have a backup generator? What happens if the power fails? What if the heart lung machine-

Adam Kaufman: The answer is yes on the generator, right?

Marc Gillinov: Yeah. A backup to a backup to a backup. "What happens if the heart lung machine stops working? What happens if they guy who runs the heart lung machine passes out?" All kinds of questions and I'm certain we have not thought of everything, but we've thought about, just about everything.

Adam Kaufman: A lot of contingencies.

Marc Gillinov: Yes.

Adam Kaufman: Back as a student, can you practice these contingencies or it's just what you read about? How do you train up to that level of emergency management control?

Marc Gillinov: Two ways. Simulation, just like with pilots.

Adam Kaufman: Okay. So you can do simulation. Cadavers and ...

Marc Gillinov: Yeah. Well actually, all computerized. Many private companies making computer simulations for various issues in medicine, whether it's procedural or diagnostic, and then real experience. That's why residency takes a few years.

Adam Kaufman: I want to kind of balance the serious with something more whimsical, but still, I think it'll be relevant to our listeners regarding dark chocolate. A lot of us really like chocolate and we justify eating it by presumably thinking it's healthy. Can you tell us that? Can you please affirm that chocolate is good for us? A grateful nation awaits for your answer.

Marc Gillinov: A small square of dark chocolate is neutral to slightly positive.

Adam Kaufman: Neutral? One small square?

Marc Gillinov: Yeah, a lot of dark chocolate, you'll have to run a few miles because that's a lot of calories.

Adam Kaufman: Why do we think it's good for us?

Marc Gillinov: Dark chocolate has more antioxidants than does milk chocolate. That bitter taste in dark chocolate that's the taste of the antioxidants. The percent cocoa is related to antioxidants. Meaning the higher the percentage, the more antioxidants. And theoretically, only theoretically, antioxidants are good for your body, good for yourselves, good for your tissues. That's true in a laboratory, in a Petri dish, in a big complex person, it's never been shown to be correct. So if you said, theoretically, "What's better, milk or dark chocolate?" The answer's theoretically dark chocolate-

Adam Kaufman: But barely.

Marc Gillinov: But just barely or maybe not at all. So if you're in a hotel and they leave a couple of pieces of chocolate by your pillow, one's dark, one's a milk. Take the dark.

Adam Kaufman: That's what I do. But just one.

Marc Gillinov: Just one.

Adam Kaufman: More than chocolate,, I love coffee. Please tell us that coffee is good for us. I know not with all the whipped cream and the flavored sugar cream, but is coffee still good for us? I believe it is.

Marc Gillinov: Yeah, overall it is. Same thing. Coffee has antioxidants. People who have a couple of cups of coffee a day seem to live longer than people who don't.

Adam Kaufman: That's good to know.

Marc Gillinov: Can't prove causality there. That's just an observation.

Adam Kaufman: A lot of doctors do say though, "Coffee's good for us."

Marc Gillinov: It's probably, again, kind of like dark chocolate. Not bad.

Adam Kaufman: This is such a downer, this conversation.

Marc Gillinov: Well, how about this? The artificial sweeteners almost certainly don't cause cancer.

Adam Kaufman: Oh, that's good. Okay. We'll get more a vanilla flavored. There's so many different versions of almond milk cream and et cetera. I can't keep up with them all, but I still love a good cup of coffee. Do you have coffee?

Marc Gillinov: Yeah, one in the morning.

Adam Kaufman: And do you have chocolate? I forgot to ask you.

Marc Gillinov: Yeah.

Adam Kaufman: Dark?

Marc Gillinov: Whatever my secretary has out.

Adam Kaufman: Okay. Well we brought both dark and a lighter chocolate, today. What about the future for you in the workplace? Are you most excited about technology? Are you most excited about genetic discovery or what really gets your belly rumbling when you think about the near term horizon for heart health?

Marc Gillinov: For cardiac surgical things, technology.

Adam Kaufman: Technology.

Marc Gillinov: Doing things better more quickly, smaller incisions, maybe even without incisions. So that's all technology. That's when you're at the point that there is an honest to goodness plumbing problem in the heart. I think that is the horizon now that we can actually see it's not a distant-

Adam Kaufman: How could that without incision occur? Through the throat or ...

Marc Gillinov: Well, it'll be a small incision in a blood vessel like the artery or vein to your leg. Sometimes the vein or artery in another part of the body. So that's dealing with the plumbing, preventing the plumbing from going bad in the beginning. That's a long ways off, long ways off.

Adam Kaufman: And is that because of just human behavior or because we're still not anywhere near where we need to be in terms of learning?

Marc Gillinov: Behavior is the thing that is theoretically controllable, but it's not.

Adam Kaufman: Right. Human nature, it's hard to control.

Marc Gillinov: Yeah. People say it's hard to herd cats. I think it's much harder to herd humans, to get them to do what's right for themselves. But the genetics of this will someday be better understood.

Adam Kaufman: Can you elaborate a little bit on the behavior? I remember one time we were traveling together somewhere, I think it might've been in Florida and you gave a talk to of mostly retired active people but retired people. And you explained, and correct me if I'm wrong, that going from no activity to walking is even of better benefit than going from being a walker to a runner.

Marc Gillinov: For sure.

Adam Kaufman: You did say that?

Marc Gillinov: Yes, some activity is far better than no activity and you get your biggest bang for the buck going from nothing to something, just walking 30 minutes a day. But if you really want to get better cardiovascular health, do something that makes you sweat.

Adam Kaufman: Get your heart rate up and makes you sweat?

Marc Gillinov: Yes. I think the question that was posed back when you gave that answer about walking was what's the easiest first step people can take just to begin to live a healthier life? So you're also saying making you sweat now. So a lot of people who are older or heavy, it's hard to do maybe a Peloton or you know, some of the other things that others can do.

Marc Gillinov: Walking's up at walking's not bad.

Adam Kaufman: Walking's not bad.

Marc Gillinov: Don't drive around for 15 minutes looking for the closest parking spot to the restaurant. Just take one that's far away and walk.

Adam Kaufman: So the onset of like wearables and Fitbit has been positive. People are counting their steps.

Marc Gillinov: I think it's good to count. We don't have any real evidence that has resulted in a health benefit. Having a Fitbit, Apple watch, Garmin, whatever, theoretically-

Adam Kaufman: I have seen them change the behavior of humans though around me. It's really remarkable. Can't hurt.

Marc Gillinov: It definitely cannot hurt. It turns out that the people who are most motivated to say get a Fitbit or a Garmin or an Apple watch-

Adam Kaufman: Are already fit.

Marc Gillinov: They're already fit.

Adam Kaufman: Exactly. That's true.

Marc Gillinov: I mean you see some triathlete wearing this super fancy Garmin watch that's got a GPS hookup. He can communicate with the space station and also knows his elevation and calorie counted every moment that guy was going to be fit no matter what.

Adam Kaufman: Just measuring himself in one additional way?

Marc Gillinov: Yes.

Marc Gillinov: What are some of the most common, though, early steps for the non triathlete, maybe keeping them away from your surgery table or recovering a few months after your procedure, what are the tips you give folks who want to begin to live healthier lives? If you smoke, do your best to quit. Still 10, 12% of Americans smoke. That's much better than it was.

Adam Kaufman: It's decreased. Right? Even since you've been a professional, I'm sure.

Marc Gillinov: Yeah, that has decreased. For exercise, it's so hard for people to stick with it. So don't do it alone. Join a class, get a personal trainer. If you're a cardiac patient, go to cardiac rehab, but make it something that appears on your Outlook calendar so that you actually do it.

Adam Kaufman: What about for yourself? Is there something that you and your wife like to do? The physical fitness side. Is at tennis or you guys take walks together?

Marc Gillinov: Running, once I can run again.

Adam Kaufman: Oh, you both run together.

Marc Gillinov: We used to. Now, she was injured for about a year and she's running again, and now I'm injured. But eventually.

Adam Kaufman: Aging, it happens to all of us.

Marc Gillinov: It's better than the alternative.

Adam Kaufman: It is better than the alternative.

Marc Gillinov: At least as far as we know.

Adam Kaufman: Can you think back, I mean you're still young, but I like to ask folks who are as successful as you are. Everything seems like it went so well in your career. But if you could go back and talk to the 21 year old version of yourself, is there any advice you would give your younger self that you've now had a chance to learn?

Marc Gillinov: Physically? I would tell my younger self don't run every day. Run every other day. Because you're going to have a certain number of steps in your legs, don't know how many it is.

Adam Kaufman: See? That worries me, for real.

Marc Gillinov: But don't use them up.

Adam Kaufman: I think about that because I'm a heavier runner and I would love to run every day, but I'm now back to every other day. But I interrupted you. Okay.

Marc Gillinov: No. There are some people who can run every other day and there are some people can run every day.

Adam Kaufman: So you would tell yourself don't run every day because you're feeling it in the joints now.

Marc Gillinov: Yeah, and I would tell myself, when you're operating, don't stand hunched over for hours on end. Every 10 or 15 minutes, stand up, look at the ceiling or sky stretch and then look back down.

Adam Kaufman: Is that related to a back problem?

Marc Gillinov: Yeah.

Adam Kaufman: I meant to say this earlier. I see a lot more stand up desks in the workplace. That's got to be a good thing. Right?

Marc Gillinov: I think overall it is tough for some of us like me who are used to sitting down and typing, to change it to standing up. It doesn't feel right.

Adam Kaufman: But as a general health improvement for society changing behavior, probably a good addition to the routine to have more stand up desks in the workplace?

Marc Gillinov: Yeah, and overall say coronary artery disease. That's what causes heart attacks. About 90% of that is related to behavior and 10% is what are your genes? How old are you or your male or female.

Adam Kaufman: So 90% of the variables we could have-

Marc Gillinov: You could control.

Adam Kaufman: That's remarkable.

Marc Gillinov: Most people don't.

Adam Kaufman: And yet, we can. So how do we get that education out? Podcasts like this? Books like the one you've written, you go on TV sometimes.

Marc Gillinov: I think education helps, but it's insufficient. Who doesn't know that smoking is bad for you?

Adam Kaufman: Right.

Marc Gillinov: Who doesn't know it's bad to weigh 300 pounds if you're five foot eight. You you can tell people that, but something novel, something new to change behaviors.

Adam Kaufman: Is the U.S. Healthier in terms of heart than other nations? Westernized nations, or are we in the middle or are we behind?

Marc Gillinov: Middle.

Adam Kaufman: Where are the healthiest heart nations?

Marc Gillinov: I think it's probably Japan, except for smoking. But the more industrialized and develop nations become, the more they become like we are, which is to say, bad.

Adam Kaufman: Do you mean by that, bad food fast food?

Marc Gillinov: Yes.

Adam Kaufman: Tougher lifestyles? So what gives you the most hope then if that's the reality of the behavior of Americans? Is there something, a trend that you're most excited about?

Marc Gillinov: No particular trend. The hope is that people of my kids' generation will want to be in good shape.

Adam Kaufman: I think I see that. I see it with 20 year olds now. If I'm 49 and I have workers around me who are 20, I feel like they're more aware of the type of food they're buying, at least, is it organic? And I know not organic is great but there seems to be more awareness at least on diet.

Marc Gillinov: I think there is and they spend so much time taking selfies and other pictures of each other that maybe they want to look at good for the pictures.

Adam Kaufman: Image. I never thought about that but I bet that would be true. Maybe the motivation isn't the proper one, but at least it'll lead to healthier selves.

Marc Gillinov: It very well could.

Adam Kaufman: I love at least what I've read, how we can move away from one size fits all prescriptions to really customizing therapeutics. Are you spending any time reading about or working on any aspect of personalized health?

Marc Gillinov: To a certain extent we've always done that. Meaning if you come in with whatever is your medical issue, we're going to figure out what is going on with you, which medicines will be most effective for you. The idea though that we will be able to predict based on your genes or your proteins for example, which antibiotic is specifically best for you, I think is going to be a time that really refines what we can do.

Adam Kaufman: Like the genetics of my family, led to discovery that I should be taking baby aspirin to reduce chances of deep vein thrombosis. That was empowering. That's just one example of personalizing. Turns out I still had that, but now other family members are doing other things to hopefully limit those chances. I guess that's the 90% behavior versus the 10% genetics factor.

Marc Gillinov: Right. It would be good to know what the genetics imply. Can't predict for certain, except for some diseases, if somebody, say, has the genes that are going to give you a certain form of breast cancer, okay, we know that, but we can't really say at this point we've got an eight year old boy and sometime in his seventies he's likely to have a heart attack. We're not even close to that sort of pronouncement.

Adam Kaufman: But are we still saying that every man over a certain age should have baby aspirin every day? For instance?

Marc Gillinov: No. Okay. It depends.

Adam Kaufman: That used to be the case, right?

Marc Gillinov: Yeah, we changed that recommendation every couple of years.

Adam Kaufman: Great.

Marc Gillinov: Which means that we're uncertain.

Adam Kaufman: Makes you more important to all of us as if that was needed.

Marc Gillinov: Yeah. You can't just come once and get the answer because we reserve the right to change the answer. So you need to keep up with things.

Adam Kaufman: Well, I want to reserve the right to continue to count on you as a friend and by doing that we're not going to overburden our time with you today. You're a very busy human being. We never take for granted how valuable your time is. So Dr. Marc Gillinov, thank you so much for being on Up2 today. We're really pleased we had this time with you.

Marc Gillinov: Thank you.

Adam Kaufman: Wow. So many terrific takeaways from this jam packed, somewhat brief discussion with heart surgeon, Marc Gillinov. Here are my takeaways for your consideration. Number one, it was really telling to me that both Dr. Gillinov, as an individual and the Cleveland Clinic as an institution are always striving to become better versions of themselves.

Adam Kaufman: For instance, Dr. Gillinov didn't apply for the leadership position at the heart center until he was convinced that he had achieved the level of skills he needed to first as a heart surgeon. So he waited an additional 10 years. Additionally, he mentioned how the Cleveland Clinic itself continues to visit other hospitals so that they can be on the cutting edge of innovation in spite of the fact they've been ranked number one in heart care for more than 20 years.

Adam Kaufman: Number two, although it may sound obvious, his admission that Dr. Gillinov is merely trying to do the best that he can, that's all that we all can do. Now, that's all that we all can do, but we should truly try to be the best that we can be in whatever we're pursuing. I heard no hint of any kind of destructive competitive nature when asking about all of the accomplishments he's made, but rather him just trying to be the best he could be.

Adam Kaufman: Number three on a lighter note, but something we can all relate to on nutrition and fitness. Going from zero activity to walking is of greater benefit even than going from being a walker to a runner. We can all do that.

Adam Kaufman: Number four, he's looked at all the studies and really there's no conclusive evidence that red wine is any better for us than white wine. The end result, looking at all this studies is that a little bit of alcohol, one serving, whether it's beer or red or white wine is equally beneficial but only in moderation.

Adam Kaufman: And number five, regarding nutrition in the United States, Dr. Gillinov feels we're not lacking education. How many people don't know smoking is bad for us? Or that too much fast food is bad for us? He emphasized it's more about behavior modification, not education.

Dave Douglas: And now, it's time for this week's listener mailbag.

Adam Kaufman: This week, my favorite mailbag and treat came from Evan in Pittsburgh, Pennsylvania. His note to me was very specific about what he enjoyed about the Bernie Marino episode. He asked me how often we release episodes. He liked hearing that they come out every two weeks because he's planning on sharing each episode with his national sales team. And then at their sales meetings, go over their takeaways and their learnings from each Up2 discussion. Wow. Thank you Evan. That means so much to us.

Dave Douglas: This is Dave Douglas, the producer of the Up2 podcast. Adam didn't know it at the time, but I had begun recording just prior to the interview, making sure everything was working properly when Adam shared something with Dr. Gillinov. It came up during the interview as well. But after sharing this clip with Adam, we both thought it was worthwhile to include it here. So here's a brief moment just before the interview actually began.

Adam Kaufman: So one of my best friends, Biff Baker, through me, you worked on his father-in-law seven years ago, and when Biff heard I was interviewing you today, he wrote you this and he took this picture.

Marc Gillinov: Oh thanks. It's autographed.

Adam Kaufman: But isn't it amazing? I mean this is what you do. Seven years. You've given this man seven years of life with his grandkids.

Marc Gillinov: Yeah. That's what we aim to do. Good looking family.

Adam Kaufman: Up2 is a production of Evergreen Podcasts. A special thanks to our producer and audio engineer, Dave Douglas. I'm your host, Adam Kaufman, and thank you so much for listening to the Up2 podcast.